Chronic or recurrent cutaneous leukocytoclastic vasculitis is one of the more difficult therapeutic challenges to the practicing dermatologist. We have used a variety of therapeutic agents to treat 44 patients with leukocytoclastic vasculitis who had chronic or recurrent disease of more than three months' duration. Sixteen cases were classified as urticarial vasculitis based on the major clinical manifestations, while the remaining 28 cases represented various patterns. Effectiveness of treatment was graded according to resolution of lesions, return to normal of abnormal laboratory findings, or the ability to lower the dosage of a second therapeutic agent (usually a corticosteroid). Systemic corticosteroids, azathioprine, and colchicine appeared to be effective in most patients. Nonsteroidal anti-inflammatory agents, sulfones, antihistamines, and antimalarials were effective only in sporadic cases. We present an approach to the treatment of this type of disorder.